Spear, 53, died at around 4 a.m. on Dec. 19, Correction officials say. The city medical examiner autopsy is still not completed, and the cause of death is currently listed as, "circumstances undetermined pending police investigation."

Some in the Correction Department have attributed Spear's death unofficially to some kind of medical disorder. The preliminary account is that Spear tried to leave the medical unit where he was housed, and when a guard stopped him, he struck the guard with his cane.

Correction staff then "restrained" him and he died as a result of his illness. Spear, the sources say, was a troublesome inmate who often refused dialysis treatment.

That account, however, flies in the face of what the Voice has learned over the past 10 days. For one thing, relatives of Spear and sources tell the Voice that autopsy photos appear to depict bruising on his face--suggesting some kind of serious physical altercation.

"There's a mark under his left eye, his ribs seemed to be protruding on his left side, and on his shoulder, you could see three marks, possibly bruises," Kelly says. "There don't appear to be any defensive wounds on his hands which mean to me he wasn't fighting anyone."

Last week, Correction Department spokesman Matthew Nerzig said the agency had "received no complaint involving this inmate from Legal Aid or elsewhere."

However, soon after Spear reached Rikers, he began having issues with his medical care. Instead of filing an inmate grievance, which he evidently did not believe would do any good, he complained repeatedly to Legal Aid's Prisoners Rights Project, which sent a series of emails to the Correction Department, sources said. (Medical care on Rikers is handled by a private contractor.)

On Sept. 26, PRP lawyers reported he was complaining that he had not been taken to dialysis for a week. A day later, he reported that doctor stopped his medications and threatened to take them away for good. On Nov. 20, PRP warned Correction officials that Spear needed frequent dialysis and medications. And on Dec. 18, one day before Spear died, PRP lawyers again begged the agency to intervene to get him his dialysis.

"Our office expressed repeated concerns about the adequacy of his medical care, and we have been informed that he suffered traumatic injury when struck by correction officers, injuries which post-autopsy photos appear to document," says Jonathan Chasan, a lawyer for the Prisoners Rights Project, declining further comment.

In November, one month before his death, Spear was angry enough about his medical treatment that, on his own, he filed a lawsuit in federal court. In the lawsuit, he alleges that a doctor Ramos and a nurse Bowen got angry when he refused to use the Rikers dialysis machine and stopped his medications "to force me to use the machine."

Spear demanded a court order returning his medications to "stop my pain and rid my body of excess water and maintain a normal blood pressure reading." "I am seeking $2 million because my blood is not cheap," he added.

Then, in a line that now could be tragically prophetic, he wrote, "Due to the fact that Dr. Ramos has stopped all my pain medications, he has caused me severe pain. And now that the Prisoners Rights Project is involved, I have correction officers retaliating against me."

In a statement responding to our more detailed questions, Correction Department spokesman Nerzig yesterday called the Voice "irresponsible" for "prematurely going to print with this story when the autopsy has not been concluded and key facts have yet to be determined."

"We can only imagine the sadness and the frustration that Mr. Spear's family must be feeling over the conflicting reports around his death," Nerzig said.

In addition to an internal DOC investigation, the Voice has learned that the Board of Correction is also investigating, and has questioned Jesse James, the inmate who called Spear's sister, Nellie Kelly, with an eyewitness account of his death.

In his call to Spear's sister, James told her that in the hours before he died, Spear had been complaining to medical staff that he wanted to be taken to an outside hospital because he was coughing up blood and had blood in his stool. James claimed that medical staffers got tired of his complaints and called in two correction officers.

James told Kelly that Spear demanded again to be taken to the hospital, saying he did not trust the doctors. The correction officers, he claimed, punched Spear, knocking him down, and then he was kicked and stomped, according to James' account. That was when he died.

An investigator tells the Voice that what James told Kelly comports with what he told investigators. "They took him to the ground, facedown, and handcuffed him, and there's some allegations of kicking, unclear who and when," the source says. "The issue is the use of force."

In the months preceding her brother's death, Kelly had repeated conversations with him about his medical care. "He said they weren't doing the dialysis properly," she recalls. "They weren't disconnecting it properly. They would leave the needle hanging and blood would be running down. So he stopped letting them do it."

Spear, she says, insisted on an outside hospital. As he alleges in the lawsuit, he told his sister that medical staff refused him heart and blood pressure medicine unless he agreed to have the dialysis held on Rikers.

Spear's stepson, Bryan Cobb, offers a similar account. "He was having a problem with one doctor, who was blowing him off, not taking him seriously, giving him a hard time," he says. "They didn't want to take him outside Rikers for dialysis."

Two days before his death, Kelly spoke with Spear again. "He said one of the guards came and told him, 'you had better watch your back because you are costing these people a lot of money,'" she says. "Plus he had put lawsuit in against this particular doctor. That was the last conversation I had with him."